inflammatory breast cancer
Introduction
Introduction to inflammatory breast cancer Inflammatory breast cancer (IBC) is a special type of breast cancer that is very rare in clinical practice. The disease is a fulminant disease characterized by diffuse redness, swelling, heat, pain and edema of the breast skin, which is very similar to acute inflammation. The degree of malignancy is high and the prognosis is poor. Inflammatory breast cancer is mainly characterized by invasion of lymphatic vessels, and has a high probability of metastasis. It is the worst prognosis in locally advanced breast cancer. The incidence rate accounts for 1% to 10% of all breast cancers, and China reports about 0.9% of breast cancer. basic knowledge Probability ratio: female prevalence is about 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: acute lymphadenitis, acute lymphangitis, abscess, sepsis
Cause
Causes of inflammatory breast cancer
Immunity factor (35%):
The cause of breast cancer is not fully understood. Inflammatory breast cancer is a type of breast cancer with rapid progression, high degree of malignancy and poor prognosis. The pathogenesis may be related to the low level of immunity of patients.
Age (20%):
The study found that women with high risk factors for breast cancer are prone to breast cancer. The high-risk age of breast cancer in Chinese women is shown by age group: it gradually rises after 25 years old, reaches the peak in the group of 50-54 years old, and gradually decreases after 55 years old.
Genetic factors (10%):
Family history of breast cancer is a risk factor for breast cancer. The so-called family history refers to breast cancer patients among first-degree relatives (mother, daughter, sister). In recent years, the discovery of dense breast glands has also become a risk factor for breast cancer.
Other factors (8%):
Risk factors for breast cancer include early menarche (<12 years old), late menopause (>55 years); unmarried, infertile, late childbirth, no breastfeeding; benign breast disease is not treated promptly; hospital biopsy (biopsy) Confirmed with atypical hyperplasia of the breast; high dose radiation in the chest; long-term use of exogenous estrogen; postmenopausal obesity; long-term excessive drinking; and carrying mutations associated with breast cancer. Women with several high risk factors have a higher risk of developing breast cancer than normal people.
Prevention
Inflammatory breast cancer prevention
1. Avoid mental stimulation, maintain emotional stability, and cultivate good psychological quality, which can enhance the body's ability to fight cancer. Moderate exercise can reduce the chance of breast cancer.
2. Get enough sunlight to get the vitamin D you need. Because vitamin D has the effect of preventing breast cancer. Guaranteed 10-15 minutes of sunshine per day to prevent breast cancer.
3. Avoid receiving too much radiation. Especially during menstruation and pregnancy, it is very sensitive to radiation and should be avoided as much as possible.
4. Proper physical protection of the breast. Breastfeeding is promoted and weaning is slow. Use a suitable bra to improve breast blood and lymph circulation.
5. Timely treatment of precancerous lesions of the breast. Such as cystic lobular hyperplasia, papilloma of the breast, mammary gland hyperplasia with epithelial hyperplasia and atypical hyperplasia.
6. Appropriate section of brake fat intake, less alcohol. Excessive consumption of meat, omelettes, butter, and animal fats increases the risk of breast cancer; green vegetables, fruits, fresh fish, and dairy products reduce the risk of breast cancer.
7. Menopausal women try to avoid using estrogen.
8. Regular regular physical examination. Experts recommend that women over the age of 35 should have breast ultrasound, lactation or mammography every 2-3 years. For those who are prone to breast cancer, those over the age of 40 should be checked once a year.
9. The following vulnerable people should strengthen their self-protection. When there is abnormality such as swelling or discharge in the breast, they should go to the hospital for examination in time, and do not delay the illness. People with a family history of breast cancer, especially mothers or sisters with breast cancer, are more likely to have their own disease; those with early menstrual early (before 12 years old) or late menstruation (after 50 years old) are more likely to have breast cancer than others. People are high; after the age of 30, the first child, the unborn or the unmarried person has more chances of breast cancer than others; repeated radiation exposure can also increase the chance of breast cancer; eating high-fat food and obesity Easy to get breast cancer.
Complication
Inflammatory breast cancer complications Complications acute lymphadenitis acute lymphangitis abscess septic
Often accompanied by fever, chills and other systemic symptoms.
There may be local lymphadenitis, lymphangitis, and even metastatic abscess, sepsis.
Symptom
Symptoms of inflammatory breast cancer Common symptoms Breast redness and heat, breast pain, breast lumps, nipple retraction, upper extremity edema, pain in the area
1. The vast majority of breast cancer patients are treated with painless breast tumors, and IBC is often treated with red, swollen, hot, painful, tender and painful breast skin symptoms. Only about 50% of them have a mass, and IBC often has a sudden onset. Breast enlargement, breast skin thickening and hardening, wrinkles, high skin temperature, reddish purple, Haagensen reported that IBC clinical symptoms include: breast lumps (57%), skin redness (57%), breast enlargement ( 48%), breast or breast headache (24%), breast tenderness (16%), breast sclerosis (16%), nipple retraction (13%), skin edema (13%), underarm mass (9%), Increased skin temperature (8%), etc., rare symptoms of IBC include: pain in the sputum area, itchiness of the nipple, upper extremity edema and bone pain, etc. Due to the rapid onset of the disease, most patients see the doctor early, the average time from the appearance of clinical symptoms to the visit is 2.5. Months.
Taylor and Meltzer divide IBC into primary and secondary. Primary IBC is a simultaneous tumor and inflammation on the original healthy breast; secondary IBC inflammatory changes are secondary to the original tumor site, surgical scar Or the mammary gland in the radiation area, the concept of secondary IBC ignores the difference in clinical and prognosis between locally advanced breast cancer and IBC, and should not be applied.
2. Signs: The signs of IBC include diffuse sclerosis of whole milk or confined to a certain quadrant or half of the breast. The skin edema is orange-like, thick and uneven. The skin is initially pink and quickly becomes a bloody purple. Red, erysipelas-like changes, breast enlargement, high skin temperature, tactile torsion, common nipple dryness, scarring and invagination, generally considered breast skin changes up to 1/3 or more of the breast can be diagnosed as inflammatory mammary gland cancer.
Examine
Examination of inflammatory breast cancer
1. Blood routine: Leukocyte elevation is not common.
2. Fine needle aspiration cytology or hollow needle biopsy: from the breast or representative hardened, edematous or reddened skin, more than a diagnosis can be established, and a biopsy can be obtained to obtain appropriate tumor or skin and subcutaneous lymphatics Organization, for the means of diagnosis.
3. Mammography: Positive findings include increased skin thickness, increased asymmetry of subcutaneous lymphatic vessels on the affected side, increased density of breast tissue, and increased vascular texture.
4. Heat map: High tropics may be found, but there is no discriminating significance.
Diagnosis
Diagnostic identification of inflammatory breast cancer
diagnosis
Because the special clinical manifestations of inflammatory breast cancer are often confused with some breast inflammation, needle aspiration cytology and local tissue biopsy are important basis for diagnosis.
Differential diagnosis
The identification of advanced inflammatory reactions caused by IBC and locally advanced non-inflammatory cancerous breast cancer invading the skin is difficult, mainly based on medical history. Other breast diseases that are easily confused with IBC and cause delayed treatment are:
1. Mastitis and breast abscess: a common misdiagnosed disease, usually only occurs in lactating women, accompanied by high fever, elevated white blood cells, the identification of the two.
2. Syphilis and tuberculosis invade the mammary gland: There are many extramammary syphilis and tuberculosis, and it is now rare.
3. Breast infiltration of lymphosarcoma or leukemia: usually only the skin of the tumor area becomes red without inflammation, but it is often difficult to identify, and more needs to be confirmed by cytology or histological examination.
